Combined trabeculotomy-trabeculectomy compared with primary trabeculectomy for congenital glaucoma.

Abstract

This paper aimed to assess the outcome of primary trabeculectomy for congenital glaucoma and to compare it with a combined trabeculotomy-trabeculectomy procedure.

Surgical outcome of primary developmental glaucoma: a single surgeon's long-term experience from a tertiary eye care centre in India

“…50 On the other hand, the disadvantage of trabeculotomy is that the Schlemm's canal may not be found in 11-15% of the procedures. 19,28 In view of these limitations, some surgeons have resorted to primary trabeculectomy in the management of PDG because primary trabeculectomy is easier than goniotomy or trabeculotomy. [51][52][53][54][55] Unfortunately, many of the patients with PDG require multiple surgeries to achieve a successful outcome.…”

“…2,4,8,[24][25][26] In the search for the best surgical treatment of developmental glaucoma, combined trabeculotomy-trabeculectomy (CTT) owing to its obvious advantages over conventional procedures has emerged as the new treatment modality. [27][28][29] Over the last decade, the good success rate of CTT reported by Elder 28 has been substantiated by other institutions and paediatric ophthalmologists. [30][31][32][33][34][35][36] The functional outcome of patients with PDG is poor; no more than 40-50% of these children achieve a vision of 20/50 or better.…”

Combined trabeculotomy and trabeculectomy in advanced primary developmental glaucoma with corneal diameter of 14 mm or more

“…Our success rate with initial surgery is significantly better than most of the reported results of initial goniotomy [6][7][8] or trabeculotomy ab externo. [9][10][11][28][29][30][31][32][33] The superior results of the combined procedure may be because of the dual outflow pathway as explained by Elder, 35 and Mandal and co-workers 3,12,[14][15][16][17][18] The additional advantage of CTT is that it allows greater surgical flexibility in advanced buphthalmos. For example, conversion to trabeculectomy is feasible in cases where identification of Schlemm's canal is not possible.…”

“…Although the combined procedure seems to have a favourable outcome, the advantages of this procedure over trabeculotomy or trabeculectomy were not statistically significant after 2 years. Elder 35 compared primary trabeculectomy with CTT and found the latter to be superior. In the present study, all patients underwent CTT and our results are comparable to those reported by Elder 35 and better than the results of goniotomy [6][7][8] or trabeculotomy, 9,11,[28][29][30][31][32][33] or trabeculectomy alone.…”

“…Elder 35 compared primary trabeculectomy with CTT and found the latter to be superior. In the present study, all patients underwent CTT and our results are comparable to those reported by Elder 35 and better than the results of goniotomy [6][7][8] or trabeculotomy, 9,11,[28][29][30][31][32][33] or trabeculectomy alone. [38][39][40] Considering the significant corneal oedema or scarring, 3601 trabeculotomy described by Beck and Lynch 41 could have been considered as an alternative surgical technique that was reported to have an 87% success rate after one procedure.…”